Intervenció grupal per reduir la violència de parella entre consumidores de drogues

Diversos estudis realitzats en països desenvolupats han mostrat que la violència de parella és més freqüent entre les dones que presenten trastorns per consum d'alcohol i/o altres substàncies. En aquest context, el Grup de Recerca en Addiccions de l'IMIM ha adaptat, dissenyat i dut a terme una intervenció grupal de 10 sessions per a dones d'elevat risc. Els resultats mostren una reducció del maltractament psicològic, l'agressivitat en la relació de parella i la freqüència de consum, així com un augment de l'assertivitat.Varios estudios realizados en países desarrollados han mostrado que la violencia de pareja es más frecuente entre las mujeres que presentan trastornos por consumo de alcohol y/u otras sustancias. En este contexto, el Grupo de Investigación en Adicciones del IMIM ha adaptado, diseñado y llevado a cabo una intervención grupal de 10 sesiones para mujeres de elevado riesgo. Los resultados muestran una reducción del maltrato psicológico, la agresividad en la relación de pareja y la frecuencia de consumo, así como un aumento de la asertividad

Patología dual: situación actual y retos de futuro

Se denomina "patología dual" a la concurrencia en un mismo individuo de, por lo menos, un trastorno por consumo de sustancias y otro trastorno psiquiátrico. Estos pacientes "duales" o con comorbilidad psiquiátrica, son frecuentes y presentan mayor gravedad tanto desde la perspectiva clínica como social que los sujetos que sólo presentan un tipo de trastorno (adictivo u otra enfermedad psiquiátrica). Se presenta un estado de la situación de la patología dual desde la perspectiva epidemiológica, clínica y terapéutica y se revisan los retos de futuro más relevantes. En los retos de futuro se hace hincapié en las necesidades de profundizar en la caracterización nosológica adecuada de la coexistencia de síntomas psicopatológicos y consumo/intoxicación/abstinencia de sustancias; la importancia de disponer de instrumentos clínicos de cribado para detectar la patología dual; la necesidad de desarrollar estrategias terapéuticas farmacológicas y psicológicas efectivas; la importancia de la atención integrada de estos pacientes por un solo equipo terapéutico en una red única de salud mental y dual a los profesionales sanitariosThe term "dual diagnosis" refers to the co-occurrence of at least one substance use disorder with another psychiatric disorder in the same individual. These "dual" patients or patients with psychiatric comorbidity are common, and present greater severity from both the clinical and social perspectives than those subjects with only one type of disorder (addictive or other psychiatric illness). We present the current situation regarding dual diagnosis from epidemiological, clinical and therapeutic perspectives and we review the most important challenges for the future. Among the challenges for the future, we highlight: the need to improve the understanding of the nosological characterisation of the co-occurrence of psychopathological symptoms and the use, intoxication and withdrawal from substances; the need for clinical screening instruments to detect dual diagnosis; the need to develop effective therapeutic strategies both pharmacological and psychological; the importance of providing integrated care to these patients by one therapeutic team within a single mental health and addiction network; and finally, the need to incorporate training on dual diagnosis for health professional

Factors associated with discharge against medical advice from an inpatient alcohol and drug detoxification unit in Barcelona during 1993-2006

Records from 1,228 consecutively admitted patients (74.5% male) to an inpatient detoxification unit in Barcelona during 1993-2006 were examined to determine factors associated with discharge against medical advice (AMA). 21.5% of admissions were discharged AMA. In multiple logistic regression and compared to patients who were medically discharged; those discharged AMA were younger, more likely to be dependent on heroin, other opiates, cocaine or psychostimulants or be receiving suppression from methadone maintenance therapy [reference category: alcohol]. Assisting clinicians to identify patients most at risk for leaving inpatient detoxification AMA will enhance their ability to motivate such patients to remain in treatment

Comorbilidad psiquiátrica y trastorno por dependencia de opiáceos: del diagnóstico al tratamiento

En los últimos años, las graves consecuencias sanitarias y sociales de la coexistencia de otros trastornos psiquiátricos en pacientes dependientes de opiáceos, han incrementado el interés por mejorar el diagnóstico y el tratamiento de estos trastornos. La identificación fiable y válida de otro trastorno psiquiátrico concomitante en los sujetos con drogodependencias ha mejorado sustancialmente con la utilización de los criterios DSM-IV y la utilización de la entrevista diagnóstica "Psychiatric Research Interview for Substance and Mental Disorders", especialmente diseñada para ello. Tomando como "patrón oro" los diagnósticos realizados con el método LEAD, mediante la entrevista PRISM-IV se obtuvieron diagnósticos válidos de depresión mayor, psicosis inducida, trastornos de ansiedad y trastornos de personalidad antisocial y límite. Así mismo, los diagnósticos obtenidos mediante la PRISM-IV mostraron mejores índices kappa que con la entrevista SCID-IV. La revisión de la literatura muestra que entre los sujetos dependientes de opiáceos que acuden a tratamiento se ha detectado una elevada prevalencia de comorbilidad psiquiátrica (47%-93%), siendo los trastornos depresivos y de ansiedad así como los trastornos de personalidad antisocial y límite los diagnósticos más frecuentes. Si bien se reconoce la necesidad de realizar tratamiento adecuado de los trastornos comórbidos, todavía no hay suficientes estudios controlados que aporten datos concluyentes sobre las pautas terapéuticas más adecuadas. En el caso de la depresión comórbida, la revisión sistemática de los ensayos clínicos controlados disponibles, avala la necesidad de nuevos estudios para clarificar las pautas de tratamientoDiagnosing and treating psychiatric comorbidity in substance abusers has become increasingly important in the last 10 years because of important consequences from a health and social point of view. The identification of reliable and valid diagnosis of psychiatric co morbidity in substance abusers has being improved using the "Psychiatric Research Interview for Substance and Mental Disorders" for DSM-IV criteria. This instrument is a structured interview designed "ad hoc" to diagnoses nonsubstance use disorders in substance abuser population. Compared to the Longitudinal, Expert, All Data (LEAD) procedure, as a "gold standard", the Spanish version of PRISM-IV seemed to be a valid instrument for diagnosing major depression, induced psychosis, anxiety disorders, antisocial and borderline personality disorders. Also the Spanish PRISM-IV resulted in better kappa statistics than the Spanish version of SCID-IV for diagnosing major depression, and borderline personality disorders in substance abusers. Many clinical studies have revealed a high degree of co-occurrence of opioid dependence and other psychiatric disorders, ranging from 44% to 93%. Major depression, anxiety disorders, antisocial and borderline personality disorders are the most prevalent non-substance use disorders in opioid dependent subjects. Most studies are needed to determinate the evidence based treatments for comorbid psychiatric disorders in opioid dependence. In the case of comorbid major depression in opioid abusers, after a systematic review of the randomized and controlled clinical trials available, new studies to clarify the evidence based treatments are require

Antiretroviral Therapy (ART) Use, Human Immunodeficiency Virus (HIV)-1 RNA Suppression, and Medical Causes of Hospitalization Among HIV-Infected Intravenous Drug Users in the Late ART Era

Background: Antiretroviral therapy (ART) has reduced the rates and changed the causes of hospital admission. However, human immunodeficiency virus-positive intravenous drug users (HIV-IDU) continue to have increased hospitalizations and discharge diagnosis are less defined in the late ART era. Our aim was to examine ART use, HIV-1 RNA suppression, and hospital discharge diagnoses among HIV-IDU admitted to an urban hospital.Methods: A retrospective analysis was made of HIV-IDU admitted for medical causes for the first time (2006-2010). Surgical, obstetric, or mental (except HIV-associated neurocognitive disorder) diagnoses were excluded. Clinical characteristics, number of admissions, and primary discharge diagnoses were determined for each patient.Results: Three hundred and seventy-five admissions were recorded among 197 hospitalized HIV-IDU. Lifetime prevalence of ART use was 83.2% (164 of 197) and the rate of HIV-1 RNA <50 copies/mL was 38.1% (75 of 197). Primary discharge diagnosis groups were as follows:acterial infections (59.2%), chronic end-organ damage (16.8%), complications derived from injected drug use (16.8%), malignancies (9.1%), and opportunistic infections (6.6%). Chronic end-organ damage was diagnosed more frequently in patients with HIV-1 RNA <50 copies/mL (36% vs 4.9%; P < .000), and complications derived from injected drug use (23.8% vs 5.3%; P < .0008) and acquired immune deficiency syndrome (AIDS) opportunistic infections (19.8% vs 1.3% P < .019) were usually diagnosed in patients with HIV-1 RNA detectable viral load. Conclusions: Human immunodeficiency virus-positive intravenous drug users are admitted to hospitals mainly for non-AIDS-related illnesses; however, sustained HIV-1 RNA viral load suppression is poor and determines hospital discharge diagnoses. Providers need to be aware of the management of HIV-related comorbidities and reinforce strategies to improve ART retention in this population

Acute Effects of the Novel Psychoactive Drug 2C-B on Emotions

Background. 2C-B (Nexus) is one of the most widespread novel psychoactive substances. There is limited information about its pharmacological properties, and few studies in humans concern its acute and chronic effects. 2C-B has been classified as a stimulant, hallucinogen, entactogen, and/or empathogen. Objectives. To evaluate the emotional, subjective, and cardiovascular effects of 2C-B. Methods. Twenty healthy recreational 2C-B users (12 women) self-administered a 20 mg dose of 2C-B. Evaluations included emotional (IAPS, FERT, and speech), subjective (visual analog scales, ARCI, VESSPA, HRS, and POMS questionnaires), and cardiovascular effects (blood pressure and heart rate). Results. Positive subjective effects predominated with a reduction of anger under the influence of 2C-B. It did, however, increase reactivity to negative emotional stimuli and decrease the ability to recognize expressions of happiness. Augmented emotionality in speech could be appreciated by others. 2C-B induced euphoria and wellbeing, changes in perceptions, and slight hallucinogenic states. Mild sympathetic actions were observed. Conclusions. The specific profile that 2C-B exerts on emotions suggests its classification as an entactogen with psychedelic properties

Concentrations of mephedrone in cases of fatal and non-fatal clinical intoxications

Peer reviewe

Drug Interactions With New Synthetic Opioids

Fentanyl, fentanyl analogs, and other new synthetic opioids (NSO) have burst onto the illegal drug market as new psychoactive substances (NPS). They are often sold as heroin to unsuspecting users and produce euphoria through their agonist action on μ- opioid receptors. Their high consumption, often combined with other substances, has led to multiple intoxications during recent years. In some countries, such as the United States, the consumption of opioids, whether for medical or recreational purposes, has become epidemic and is considered a public health problem. Fentanyl analogs are more potent than fentanyl which in turn is 50 times more potent than morphine. Furthermore, some fentanyl analogs have longer duration of action and therefore interactions with other substances and medicines can be more serious. This review is focused on the potentially most frequent interactions of opioid NPS taking into account the drugs present in the reported cases of poly-intoxication, including other illegal drugs of abuse and medication. Substances involved are mainly antidepressants, antihistamines, antipsychotics, benzodiazepines, analgesics, anesthetics, psychostimulants, other opioids, alcohol, and illegal drugs of abuse. The interactions can be produced due to pharmacokinetic and pharmacodynamic mechanisms. Naloxone can be used as an antidote, although required doses might be higher than for traditional opioid intoxications. It is crucial that doctors who habitually prescribe opioids, which are often misused by patients and NPS users, be aware of designer opioids' potentially life-threatening drug-drug interactions in order to prevent new cases of intoxication